General Practice
General practice billing covers a wide range of services, from preventive care and chronic disease management to acute illness treatment. Due to the variety of procedures and insurance policies, accurate coding, documentation, and claims management are crucial for maintaining a steady cash flow. Here’s how general practitioners can optimize their medical billing process.
Common Challenges in General Practice Billing
1.Frequent Patient Visits & Service Complexity
- General practitioners handle preventive check-ups, sick visits, chronic disease management, and minor procedures.
- Proper use of evaluation and management (E/M) codes ensures correct reimbursement.
2.Insurance Eligibility & Coverage Verification
- Patients often have multiple insurance plans, high deductibles, or changing policies.
- Incorrect insurance information leads to claim denials and delayed payments.
3.Preventive vs. Problem-Oriented Visits
- Many insurers fully cover preventive services but require copays for problem-focused visits.
- Use Modifier 25 when billing a preventive visit alongside a sick visit to indicate separate services.
4.Chronic Disease Management & Medicare Compliance
- Chronic care management (CCM) services, such as for diabetes or hypertension, require specific CPT codes (99490, 99487, 99491).
- Medicare and private insurers have different coverage rules for CCM and annual wellness visits.
5.Telehealth & Remote Patient Monitoring (RPM) Billing
- Telemedicine visits require POS 10 (patient’s home) or POS 02 (other telehealth locations) and appropriate modifiers (95, GT).
- RPM services use CPT codes 99453, 99454, 99457 and require patient consent.
Best Practices for Successful General Practice Billing
1. Verify Patient Insurance Before Each Visit
- Confirm eligibility, coverage details, and copays before providing services.
- Determine whether prior authorization is required for certain procedures or medications.
2. Use Accurate CPT Codes & Modifiers
Common General Practice CPT Codes:
- 99202-99215 – Office visits (new & established patients)
- 99381-99397 – Preventive care visits
- 99490-99491 – Chronic care management
- 90471-90472 – Vaccine administration
Modifier 25:
- When billing a preventive and sick visit on the same day.
3. Optimize Documentation for Medical Necessity
- Each patient encounter should include chief complaint, history, examination findings, diagnosis, and treatment plan.
- Chronic disease visits should document changes in patient condition and treatment modifications.
4. Submit Clean Claims & Manage Denials Efficiently
- Double-check patient demographics, insurance details, and provider credentials before submitting claims.
- Address denied claims promptly and resubmit with necessary corrections or documentation.
5. Stay Updated on Medicare, Medicaid & Commercial Insurance Policies
- Regularly review CMS updates, payer-specific billing policies, and coding changes.
- Ensure compliance with HIPAA regulations and maintain proper patient records.
How Malakos Healthcare Solutions Can Help
At Malakos Healthcare Solutions, we specialize in general practice medical billing, ensuring accurate claims submission, faster reimbursements, and reduced denials. Our team of billing experts handles coding, insurance verification, and revenue cycle management, so you can focus on patient care.